In Your Opinion, What Is Holding USA EMS Back?

[Dustdevil]

IMHO WE HAVE AN IDENTITY CRISIS… Until we know who we are, we will never have a voice.

Until we have voice, nothing will change.

That is indeed the bottom line. We have failed miserably at establishing an identity in almost four decades. That is inexcusable. Because of that, the comparisons to other professions is almost necessary. When people want to know what we are, we have to give them a frame of familiar reference. Everybody knows what a nurse and a doctor is. Consequently, it is just natural for us to say, "Well, we're kinda like nurses, but...". And we are not alone in that. In fact, a lot more people have a basic idea of what we are all about than they do a Respiratory Therapist or a Perfusionist. The interesting thing is that RTs and Perfusionists continue to see progress in their professions. We don't. So while identity is indeed important, it isn't everything. But yeah, especially since we, more than other medical professions, serve the general public, and not a small subset of hospitalised patients, we have to have broad public understanding and support in order to grow.

Of course, it's a Catch-22. We can't really progress until we have an identity. But we can't really have a clear identity until we progress beyond being a hobby in half of the country, and nothing but a part-time duty for firemonkeys in the other half.

In other words, it's hopeless. There is no possible solution that does not involve totally trashing the current system and starting over from scratch.

[spenac]

No improvement will ever be had as everyone is focused on themselves and their areas. When someone has another opinion they are beat down. No organization will ever happen because it's obvious we would rather beat the hell out of each other so management and government will continue to abuse those of us idiots that chose this as a profession. What a bad choice on my part.

[JPINFV]

Who is John Galt?

[VentMedic]

In fact, a lot more people have a basic idea of what we are all about than they do a Respiratory Therapist or a Perfusionist.

Actually you could name just about any of the allied health professions and few people either lay or EMS personnel knows much about them. And actually, some that think they know the nursing profession really don't know except for isolated areas of experience.

Physical Therapists: Doctorate level of education

OT, SLT: Bachelors and Masters

RT: Associates and Bachelors

1. Each has strong national organization with state affiliates

2. National and state organizations have strong lobbists for state and national legislature.

3. Each has nationally recognized exams for entry, advanced and specialty levels provided by the same nationally recognized organization.

4. Licensure by each state with retroprocity.

5. Each only allows x amount of time for the slackers to get with the rest of the flock for each educational increase.

6. Each strictly monitors CEUs.

7. Solid educational foundation makes the addition of skills and growth opportunities within an easier reach.

8. One's worth to each profession is not necessarily measured by the number of "skills".

9. Entry level education for these professions is equal or greater than RNs so there is a more level playing field.

10. Each profession spends more time contemplating on how to improve themselves for better patient care by education, monitoring and lobbying for patients' benefits than worrying about what an EMT or Paramedic might call them. Their patients know who they are when they need them.

And yes, even some members of this forum will refer to a Respiratory Therapist as a Respiratory or even Inhalation Tech. I may correct them or I may not. If you are my respiratory patient I will give you my correct title. If I am working on you as a Paramedic that is the title I will use. I may or may not bogle your brain with terms like CCEMT-P or whatever. I also understand that not everyone got the memo on what the new terminology is for the day. Both RT and EMS have changed and/or added credentials over the past few years. RT now only has two primary credentials with a few specialty. All require a minimum of Associates for entry level.

In EMS, we have confused the system, the public and ourselves with the many certifications, inconsistent credentialing and lack of education standards. As I have stated before, when an ambulance arrives a program should be given to the public giving the titles and duties of each member of the crew. With all of the different certifications, do you honestly think the program would be an easy read?

I am still trying to figure out the recent thread with and with the Kansas EMT-B/RN/IV/First Responder/volunteer FF thing.

[WANTYNU]

How much do believe, and what is the fight worth?

I propose the establishment of a EMS governing body, with a volunteer board, and a paid staff. Its sole purpose is to create, lobby and enforce standards across the country.

How much would you contribute?

-w

[VentMedic]

How much do believe, and what is the fight worth?

I propose the establishment of a EMS governing body, with a volunteer board, and a paid staff. Its sole purpose is to create, lobby and enforce standards across the country.

How much would you contribute?

-w

I've seen many attempts over the past 3 decades of this at both the state and national levels. There are several organizations that do collect dues but none have established enough clout to get the game into play.

Reasons:

1. There are more non-degreed EMS workers than degreed (EMS degrees). They may not be willing to join an organization that is pushing education in fear of job security or egos.

2. EMS workers mistakenly believe a union, to which they are already paying dues, is their "professional" organization.

Other professionals, which I mentioned in a previous post, are not as isolated as EMS workers. Although, I believe some of this isolation for EMS workers is by choice and not necessarily the nature of the job since there is still interaction with other professions even on BLS transports. It is, however, easy to compare within the hospital walls what you need to run with the big dogs. The difference between having a tech status vs professional is very noticeable in patient rounds with members of other professions.

Each state, which already has an EMS board and lobbyists, must initiate the change. If EMS workers start to petition their state's EMS board and ask why they have not been proactive for education like Oregon or Texas, they may have to provide and answer. If one looks at the legislature passed within the states for funding, it is in favor of the big organizations, either private or public. These are easy to slip through because very few EMS workers take an active interest in the government section of their state's website. They then act surprised when they hear some organization got money for a new supervisors's cars or whatever.

Starting at the state level can be individual at first. Writing letters to the board and questioning various pieces of legislature is a start. The more people you can get, the recognition and the possibility of a response either public or private. Start a paper trail.

It has been a long battle in the state of Florida which is a leader in the world of Medic Mills. However, I am now noticing a couple of "career schools" offering an Associates degree in EMS which is accredited by "private post secondary" organizations. This could just be because their educational credits transfer to few if any state colleges or they want another $10 -$20k from their students by promoting the way of the future. Florida does offer fully accredited 2 year EMS degrees at just about every community college. Currently, it seems that no matter how much we try to keep the students in college after they finish just the certificate, they become influenced by the working world with little foresight for their future.

Accreditation (CoAEMSP/CAAHEP} for EMS programs is set with a deadline of 2012 for the NREMT test. The state of California has already required schools to be accredited since 2003. If the paramedic training at a tech school is accredited, it may be easier to receive some college credit to continue on to a degree.

With this in motion, I believe each state should ask their EMS education directors if it is feasible for their state to change to a degree requirement for licensure within 5 - 10 years. If that is deemed obtainable, the state should set the deadline in the statutes.

People that only obtain certificate training as Paramedic or those who don't advance to a degree by the deadline would be grandfathered in with a designation on their license that they are of lesser education. They would still be recognized as Paramedics but if someone was to look up their status on line they would see they are not degreed. This could now be also used as a factor for promotion since the standards are higher. After the deadline, degree only to apply for licensure.

Those that would oppose an increase in educational standards such as the FF union may be found to be unpopular by the media and the aging baby boomers who are well educated.

[cookiemonka]

Honestly, we are the newest medical profession by far. It took close to a century for nursig to begin to get some respect and we are far from that still. If we continue to prove ourselves in our profession and show the world who we are, then it will be much easier! I think a uniform nationwide protocol would be great! In some states, a medic can perform a surgical cric and in others, you have to ask permission to do any skill (including IVs and basic meds). I can see why the public is a bit confused and think we should have national standards. Also, I believe the basic truck should be done away with. All units should become ALS nationwide and keep the same level of skill on all. Even if you say "all I do is dialysis and granny transfers", you never know what can happen and it is nice to have a medic on hand.

[VentMedic]

Honestly, we are the newest medical profession by far.

Actually EMS is not the newest medical profession. There have been many technological advancements in the last 3 decades that have created positions for professionals who initially started as techs/OJTs that are now degreed and licensed. These professionals also practice advanced skills to coincide with their education.

EMS has been around for over a century in some form or another but utilized physicians, nurses and morticians in the early years. Early modern EMS got the idea that it could teach unskilled and minimally educated people, who were able to respond faster, a few life saving skills in the 1960s. It is just unfortunate that this mentality has stayed with EMS for the last 4 decades.

[boneknuckleskin]

I've got a gripe about rural services. I recently was at a very large ER in a rural part of Texas that served the entire region, I saw an ambulance with the insignia of a three hour away county down the side parking in the bay, when out jumps a filthy looking young female all decked out in her unwashed, loosely clinging street clothes, hair unkempt, and a pair of flip flops. She had the appearance of jumping right out of the crackhouse and into the back of that ambulance. Granted, not the story with all rural services. I deduced her to be an ECA, maybe not. Some seem to think their sacrifice excuses them from all forms of professionalism. They often get their training in the same county they volunteer, classes held in the back of a barn. This makes me glad that NR is phasing out non-accredited schools in the approaching years. I wish all employers would do the same. In part it's our own kind that hold us back with lack of ambition.

[Dustdevil]

She had the appearance of jumping right out of the crackhouse and into the back of that ambulance. Granted, not the story with all rural services. <snip> Some seem to think their sacrifice excuses them from all forms of professionalism.

Appearance is only one of a multitude of sins that volunteers attempt to excuse with the arrogant, self-serving excuse of "what do you want for free?" It is the same excuse they use in an attempt to justify lack of availabiiity, lack of education, and lack of commitment among other things. All too often, their attitude is, "my community is lucky to have me, because without me, they've got nothing!" Consequently, you get people with an overinflated sense of importance, who think it's okay to just make up their own rules as they go. And, of course, volunteers comprise such a large percentage of EMS providers (using the term loosely) in the U.S., that the image they present affects us all.

Kill 'em all. Let Jehovah sort 'em out.